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Pain Syndrome (pain + syndrome)
Kinds of Pain Syndrome Terms modified by Pain Syndrome Selected AbstractsUNRAVELLING THE PATHOPHYSIOLOGY OF COMPLEX REGIONAL PAIN SYNDROME: FOCUS ON SYMPATHETICALLY MAINTAINED PAINCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 7 2008Gael F Gibbs SUMMARY 1In diseases such as complex regional pain syndrome (CRPS), where neuropathic pain is the primary concern, traditional pain classifications and lesion descriptors are of limited value. To obtain better treatment outcomes for patients, the underlying pathophysiological mechanisms of neuropathic pain need to be elucidated and analysed so that therapeutic targets can be identified and specific treatments developed. 2In the present review, we examine the current literature on sympathetically maintained pain (SMP), a subset of neuropathic pain, within the context of CRPS. Evidence from both human and animal studies is presented and discussed in terms of its support for the existence of SMP and the mechanistic information it provides. 3We discuss three current hypotheses that propose both a site and method for sympathetic,sensory coupling: (i) direct coupling between sympathetic and sensory neurons in the dorsal root ganglion; (ii) chemical coupling between sympathetic and nociceptive neuron terminals in skin; and (iii) the development of a-adrenoceptor-mediated supersensitivity in nociceptive fibres in skin in association with the release of inflammatory mediators. 4Finally, we propose a new hypothesis that integrates the mechanisms of chemical coupling and a-adrenoceptor-mediated supersensitivity. This hypothesis is based on previously unpublished data from our laboratory showing that a histological substrate suitable for sympathetic,sensory coupling exists in normal subjects. In the diseased state, the nociceptive fibres implicated in this substrate may be activated by both endogenous and exogenous noradrenaline. The mediating a-adrenoceptors may be expressed on the nociceptive fibres or on closely associated support cells. [source] Suspected Complex Regional Pain Syndrome in 2 HorsesJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 4 2006Niamh M. Collins First page of article [source] What Does the Mechanism of Spinal Cord Stimulation Tell Us about Complex Regional Pain Syndrome?PAIN MEDICINE, Issue 8 2010Joshua P. Prager MD Abstract Spinal cord stimulation (SCS) can have dramatic effects on painful, vascular, and motor symptoms of complex regional pain syndrome (CRPS), but its precise mechanism of action is unclear. Better understanding of the physiologic effects of SCS may improve understanding not only of this treatment modality but also of CRPS pathophysiology. Effects of SCS on pain perception are likely to occur through activation of inhibitory GABA-ergic and cholinergic spinal interneurons. Increased release of both neurotransmitters has been demonstrated following SCS in animal models of neuropathic pain, with accompanying reductions in pain behaviors. Effects of SCS on vascular symptoms of CRPS are thought to occur through two main mechanisms: antidromic activation of spinal afferent neurons and inhibition of sympathetic efferents. Cutaneous vasodilation following SCS in animal models has been shown to involve antidromic release of calcitonin gene-related peptide and possibly nitric oxide, from small-diameter sensory neurons expressing the transient receptor potential V1 (TRPV1) receptor. The involvement of sympathetic efferents in the effects of SCS has not been studied in animal models of neuropathic pain, but has been demonstrated in models of angina pectoris. In conclusion, SCS is of clinical benefit in CRPS, and although its mechanism of action merits further elucidation, what little we do know is informative and can partially explain some of the pathophysiology of CRPS. [source] Effectiveness of Acupuncture in Patients with Category IIIB Chronic Pelvic Pain Syndrome: A Report of 97 PatientsPAIN MEDICINE, Issue 4 2010Volkan Tugcu MD Abstract Objective., Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is of significant interest in urology and unfortunately, the therapy modalities recommended are not fully effective. Therefore, we undertook a pilot study to determine whether acupuncture improves the pain, voiding symptoms, and quality of life in men with category IIIB CP/CPPS. Design., Prospective, one-group trial, cohort study. Setting., Outpatient urology clinic. Patients and Interventions., Ninety-seven CP/CPPS patients received six sessions of acupuncture to the BL-33 acupoints once a week. The National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was completed by each patient before and after the treatment and on 12th and 24th weeks following the treatment. Outcome Measures., Mean values of total CPSI score, pain subscore, urinary subscore, and quality of life subscore after the treatment and on follow-up after the treatment were compared with the baseline values. Results., There was a statistically significant decrease in all of the subscores evaluated at all periods compared with the baseline. Eighty-six patients out of 93 (92.47%) were NIH-CPSI responders (more than 50% decrease in total NIH-CPSI score from baseline) at the end of the treatment. Conclusions., The results of this study suggest that acupuncture appears to be a safe and potentially effective treatment in improving the symptoms and quality of life of men clinically diagnosed with CP/CPPS. [source] Nonimmersive Virtual Reality Mirror Visual Feedback Therapy and Its Application for the Treatment of Complex Regional Pain Syndrome: An Open-Label Pilot StudyPAIN MEDICINE, Issue 4 2010Kenji Sato MD Abstract Objective., Chronic pain conditions such as phantom limb pain and complex regional pain syndrome are difficult to treat, and traditional pharmacological treatment and invasive neural block are not always effective. Plasticity in the central nervous system occurs in these conditions and may be associated with pain. Mirror visual feedback therapy aims to restore normal cortical organization and is applied in the treatment of chronic pain conditions. However, not all patients benefit from this treatment. Virtual reality technology is increasingly attracting attention for medical application, including as an analgesic modality. An advanced mirror visual feedback system with virtual reality technology may have increased analgesic efficacy and benefit a wider patient population. In this preliminary work, we developed a virtual reality mirror visual feedback system and applied it to the treatment of complex regional pain syndrome. Design., A small open-label case series. Five patients with complex regional pain syndrome received virtual reality mirror visual feedback therapy once a week for five to eight sessions on an outpatient basis. Patients were monitored for continued medication use and pain intensity. Results., Four of the five patients showed >50% reduction in pain intensity. Two of these patients ended their visits to our pain clinic after five sessions. Conclusion., Our results indicate that virtual reality mirror visual feedback therapy is a promising alternative treatment for complex regional pain syndrome. Further studies are necessary before concluding that analgesia provided from virtual reality mirror visual feedback therapy is the result of reversing maladaptive changes in pain perception. [source] Postdural Puncture Headache in Complex Regional Pain Syndrome: A Retrospective Observational StudyPAIN MEDICINE, Issue 8 2009Alexander G. Munts MD ABSTRACT Objective., To describe the unusual course of postdural puncture headache (PDPH) after pump implantation for intrathecal baclofen (ITB) administration in patients with complex regional pain syndrome (CRPS)-related dystonia. Design., Case series based on data collected from 1996 to 2005. Setting., Movement disorders clinic, university hospital. Patients., A total of 54 patients with CRPS-related dystonia who were treated with ITB. Results., A high incidence (76%) and prolonged course (median 18 days, range 2 days to 36 months) of PDPH was found. Radionuclide studies performed in two patients with long-lasting symptoms (12,16 months) did not reveal cerebrospinal fluid (CSF) leakage. In patients without signs of CSF leakage (N = 38), epidural blood patches administered in 24 patients were effective in 54%, while ketamine infusions administered in six patients were effective in 67%. Conclusions., Our observations may suggest that other mechanisms besides intracranial hypotension play a role in the initiation and maintenance of PDPH in CRPS and stimulate new directions of research on this topic. [source] Role of Biphosphonates and Lymphatic Drainage Type Leduc in the Complex Regional Pain Syndrome (Shoulder,Hand Syndrome)PAIN MEDICINE, Issue 1 2009Andrea Santamato MD ABSTRACT Background., Complex regional pain syndrome (CRPS) is a clinical entity that has been termed in numerous ways in the last years. Clinically, CRPS describes an array of painful conditions that are characterized by a continuing (spontaneous and/or evoked) regional pain that is seemingly disproportionate in time or degree to the usual course of any known trauma or other lesion. The pain is regional and usually has a distal predominance of abnormal sensory, motor, sudomotor, vasomotor, and/or trophic findings. Design., Case report. Setting., University Medical Center. Patients., In this report, we described the case of a 68-year-old hemiplegic female affected by cerebrovascular accident that presented a clinical case of CRPS shoulder,hand syndrome (CRPS-SHS) at the right hand after a hemorrhagic stroke. Interventions., This report evaluated the effects of biphosphonates and lymphatic drainage type Leduc in CRPS-SHS. Outcome Measures., The pain level of the patients was measured with the visual analog scale. A scoring system for the clinical severity of CRPS-SHS, laboratory tests, and X-ray films were also performed. Results., We reported in this patient a great improvement of pain and edema of the right hand, with a significant reduction of bone demineralization. Conclusions., This combined treatment may be a viable alternative for this syndrome; however, further investigation is needed to determine its reproducibility in large case series. [source] DICHOTOMY OF CORTICAL PAIN PROCESSINGPAIN MEDICINE, Issue 2 2002Article first published online: 4 JUL 200 Jahangir Maleki, Rollin M. Gallagher, Pain Medicine and Rehabilitation Center, MCP/Hahnemann School of Medicine Introduction: Functional MRI and PET studies of cortical pain processing indicate segregated pain pathways above the thalamus. Although experimental pain may result in multiple areas of altered cortical activity, it is postulated that thalamic pain fibers known as the lateral system, projecting to sensory cortex, serve to localize pain, whereas medial pathways projecting to limbic cortex, process affective aspects of pain. Case Study: A 27 y/o female, with left upper extremity pain and severe allodynia from Complex Regional Pain Syndrome, Type I (CRPS I / RSD), after receiving intra-pleural bupivacaine blocks developed an ipsilateral focal-onset secondary generalized tonic clonic seizure. This was followed by one hour of post-ictal confusion. Simultaneously she developed a dense left-sided motor and sensory deficit (Todd's palsy) with a motor deficit resolving in one day whereas a sensory deficit lasted 2 days. Throughout the duration of the sensory deficit she denied any left arm pain, although she continued to report the same intensity of pain, but now localized to her epigastric region. Interestingly, despite the lack of sensory perception on the left side, palpation of her left arm resulted in increased epigastric pain and suffering. Discussion: This case indicates a bifurcation of the pain pathway between the thalamus and cortex. Due to focal seizure activity, the sensory cortex (i.e. lateral system) was transiently rendered dysfunctional, during which time the continued presence of pain and allodynia without appropriate localization likely resulted from pain conduction, from the thalamus to functional limbic structures such as Cingulum (i.e. via the medial fibre system). Conclusion: This case report strongly supports the hypothesis of medial and lateral pain conducting fibers branching at the level of thalamus with medial sub-serving the emotional aspects of pain by projection to limbic cortex, whereas lateral fibres project to sensory cortex, primarily serving a localizing function. [source] Millon Behavioral Health Inventory Scores of Patients With Chronic Pain Associated with Myofascial Pain SyndromePAIN MEDICINE, Issue 4 2001David A. Fishbain MSc, FAPA Objectives., Normative data for the coping styles and psychogenic attitudes of the Millon Behavioral Health Inventory (MBHI) for male and female chronic pain patients (CPPs) with mixed pain diagnoses have previously been reported and compared with normative MBHI manual data. However, results from other studies have suggested that CPPs with myofascial pain syndrome (MPS) may need to be considered as a distinct group in psychiatric/psychological studies. The purpose of the present study was then to provide normative data for each MBHI scale for male and female CPPs with MPS and to compare these data with MBHI manual norms for similarities and differences. Setting.,Multidisciplinary pain facility. Patients.,CPPs with an associated diagnosis of MPS. Outcome Measure.,MBHI base rate scores. Methods. CPPs with an associated diagnosis of MPS were first broken down into two groups: males and females. Analyses were then performed using the MBHI base rate scores of these two groups. For each group, the percentages of CPPs who had a base rate of 75 or above were calculated for each individual coping style and psychogenic attitude. These percentages were then compared by chi square with percentages of patients with base rate scores of 75 or above for each coping style and psychogenic attitude to the MBHI Manual normative sample. Results., Female CPPs with MPS differed from MBHI Manual normative counterparts on two of the six psychogenic attitude scales (future despair and somatic anxiety); no differences were found in any of the eight coping style scales. Male CPPs with MPS differed from MBHI Manual normative counterparts on one coping style scale (sociable) and three psychogenic attitude scales (premorbid pessimism, future despair, and somatic anxiety). Conclusions., The pattern of the results indicated that CPPs with MPS, especially males, differ from the MBHI Manual normative data counterparts. These differences appear to be greater than those for CPPs with mixed pain diagnoses. Differences in MBHI scale scores between CPPs with MPS and MBHI Manual normative data counterparts may be related to a number of issues, such as whether differences in state factors reflecting depression and anxiety might affect trait factors purportedly measured by the MBHI. [source] Limbically Augmented Pain Syndrome: An Explanatory Model for Pain, Mood, and ExperiencePAIN MEDICINE, Issue 1 2000Rollin M. Gallagher MD [source] Current Understandings on Complex Regional Pain SyndromePAIN PRACTICE, Issue 2 2009Marissa De Mos MD Abstract The mechanisms underlying complex regional pain syndrome (CRPS) have been increasingly studied over the past decade. Classically, this painful and disabling disorder was considered to emerge from pathology of the central nervous system. However, the involvement of additional peripheral disease mechanisms is likely, and recently these mechanisms have also attracted scientific attention. The present article provides an overview of the current understandings regarding pathology of the autonomic and somatic nervous system in CRPS, as well as the roles of neurogenic inflammation, hypoxia, and the contribution of psychological factors. Potential connections between the separate disease mechanisms will be discussed. Additionally, currently known risk factors for CRPS will be addressed. Insight into risk factors is of relevance as it facilitates early diagnosis and tailored treatment. Moreover, it may provide clues for further unraveling of the pathogenesis and etiology of CRPS. [source] Complete Recovery From Intractable Complex Regional Pain Syndrome, CRPS-Type I, Following Anesthetic Ketamine and MidazolamPAIN PRACTICE, Issue 2 2007Ralph-Thomas Kiefer MD Abstract Objective: To describe the treatment of an intractable complex regional pain syndrome I (CRPS-I) patient with anesthetic doses of ketamine supplemented with midazolam. Methods: A patient presented with a rapidly progressing contiguous spread of CRPS from a severe ligamentous wrist injury. Standard pharmacological and interventional therapy successively failed to halt the spread of CRPS from the wrist to the entire right arm. Her pain was unmanageable with all standard therapy. As a last treatment option, the patient was transferred to the intensive care unit and treated on a compassionate care basis with anesthetic doses of ketamine in gradually increasing (3,5 mg/kg/h) doses in conjunction with midazolam over a period of 5 days. Results: On the second day of the ketamine and midazolam infusion, edema, and discoloration began to resolve and increased spontaneous movement was noted. On day 6, symptoms completely resolved and infusions were tapered. The patient emerged from anesthesia completely free of pain and associated CRPS signs and symptoms. The patient has maintained this complete remission from CRPS for 8 years now. Conclusions: In a patient with severe spreading and refractory CRPS, a complete and long-term remission from CRPS has been obtained utilizing ketamine and midazolam in anesthetic doses. This intensive care procedure has very serious risks but no severe complications occurred. The psychiatric side effects of ketamine were successfully managed with the concomitant use of midazolam and resolved within 1 month of treatment. This case report illustrates the effectiveness and safety of high-dose ketamine in a patient with generalized, refractory CRPS. [source] Lumbar and Thoracic Sympathetic Radiofrequency Lesioning in Complex Regional Pain SyndromePAIN PRACTICE, Issue 3 2002G. B. Racz MD First page of article [source] Epidural Infusion of Opiates and Local Anesthetics for Complex Regional Pain SyndromePAIN PRACTICE, Issue 2 2002Sami Moufawad MD CRPS-I consists of multiple signs, including autonomic dysfunction, in the form of edema, vasomotor changes, motor dysfunctions, muscle spasms, tremors and dystonia, as well as burning pain, hypersensitivity and allodynia that could present in any combination. The treatment is progressive physical therapy rehabilitation program. Multiple analgesic modalities have been used to facilitate the rehabilitation program with varying rates of success. The most successful treatment is a multi-disciplinary comprehensive approach, where initial pain control allows for physical and psychological interventions that are believed to be the basis for successful treatment.1 The pain in CRPS-I may be mediated through the sympathetic nervous system, sympathetic maintained pain (SMP) or sympathetic independent pain (SIP)2. [source] Management of Chronic Pain Syndromes: Issues and InterventionsPAIN MEDICINE, Issue 2005Article first published online: 28 JUL 200 First page of article [source] A Review of Sympathetically Maintained Pain Syndromes in the Cancer Pain Population:PAIN PRACTICE, Issue 4 2001The spectrum of ambiguous entities of RSD, other pain states related to the sympathetic nervous system Abstract: Accepted wisdom contends that sympathetically maintained pain is rare in cancer pain syndromes. But this may be more of an artifact of how we diagnose this condition than a reflection of its true prevalence. One area in which one might suspect this to be true is in postsurgical states. While there are case reports of sympathetically maintained pain occurring after radical neck dissection, orbital and maxillary exenteration, it has not been reported in the more common areas of postsurgical pain. For instance, although one should suspect that the nerve damage that accompanies post-thoracotomy and postmastectomy pain syndromes would bring into being a certain incidence of sympathetically maintained pain, it is difficult to find collaborative reports. This may have more to do with the difficulty inherent in diagnosing sympathetically maintained pain than its actual contribution to these persistent cancer pain syndromes. The reason that it is more commonly reported in limb amputation is less comprehensible since blocking the sympathetic fibers that travel to an extremity is easier than those going to the thoracic cavity. In addition to surgically induced sympathetically maintained pain, medical patients with lymphoma and leukemia may have an element of sympathetically maintained pain when they develop postherpetic neuralgia. While the contribution of sympathetically maintained pain in these cases is not totally ignored, its involvement, as in the surgical patients mentioned above, is worthy of another analysis. This paper will discuss the topics introduced above and suggest diagnostic and therapeutic options available for this condition. [source] Atlas of Uncommon Pain SyndromesANAESTHESIA, Issue 7 2003I. Hart No abstract is available for this article. [source] Computed Tomography Coronary Angiography for Rapid Disposition of Low-risk Emergency Department Patients with Chest Pain SyndromesACADEMIC EMERGENCY MEDICINE, Issue 2 2007Judd E. Hollander MD Background Patients with recent normal cardiac catheterization are at low risk for complications of ischemic chest pain. Computed tomography (CT) coronary angiography has high correlation with cardiac catheterization for detection of coronary stenosis. Therefore, the investigators' emergency department (ED) incorporated CT coronary angiography into the evaluation of low-risk patients with chest pain. Objectives To report on the 30-day cardiovascular event rates of the first 54 patients evaluated by this strategy. Methods Low-risk chest pain patients (Thrombolysis In Myocardial Infarction [TIMI] score of 2 or less) without acute ischemia on an electrocardiogram had CT coronary angiography performed in the ED. If the CT coronary angiography was negative, the patient was discharged home. The main outcomes were death and myocardial infarction within 30 days of ED discharge, as determined by telephone follow up and record review. Data are presented as percentage frequency of occurrence with 95% confidence intervals (CIs). Results Of the 54 patients evaluated, after CT coronary angiography, 46 patients (85%) were immediately released from the ED, and none had cardiovascular complications within 30 days. Eight patients were admitted after CT coronary angiography: one had >70% stenosis, five patients had 50%,69% stenosis, and two had 0,49% stenosis. Three patients had further noninvasive testing; one had reversible ischemia, and catheterization confirmed the results of CT coronary angiography. All patients were followed for 30 days, and none (0; 95% CI = 0 to 6.6%) had an adverse event during index hospitalization or at 30-day follow up. Conclusions When used in the clinical setting for the evaluation of ED patients with low-risk chest pain, CT coronary angiography may safely allow rapid discharge of patients with negative studies. Further study to conclusively determine the safety and cost effectiveness of this approach is warranted. [source] Echocardiographic Diagnosis of Apical Hypertrophic Cardiomyopathy with Optison ContrastECHOCARDIOGRAPHY, Issue 6 2002Jagruti Patel M.D. We describe a case of obstructive apical hypertrophic cardiomyopathy in a 61-year-old Caucasian female with a history of chest pain syndrome. The patient was referred to the echo lab by her nuclear cardiologist, who was impressed by her abnormal stress nuclear perfusion scan that showed marked increased uptake of radioisotope at the left ventricular (LV) apex. The patient had deep negative T waves on her electrocardiogram similar to those originally described in the Japanese population. Transthoracic echocardiography with native harmonic imaging was suboptimal for visualizing LV segments. Therefore, 0.5 cc of Optison contrast was given intravenously, with repeat transthoracic imaging confirming the diagnosis. The patient and her family were referred for additional genetic testing and cardiovascular workup. [source] EFNS guidelines on neurostimulation therapy for neuropathic painEUROPEAN JOURNAL OF NEUROLOGY, Issue 9 2007G. Cruccu Pharmacological relief of neuropathic pain is often insufficient. Electrical neurostimulation is efficacious in chronic neuropathic pain and other neurological diseases. European Federation of Neurological Societies (EFNS) launched a Task Force to evaluate the evidence for these techniques and to produce relevant recommendations. We searched the literature from 1968 to 2006, looking for neurostimulation in neuropathic pain conditions, and classified the trials according to the EFNS scheme of evidence for therapeutic interventions. Spinal cord stimulation (SCS) is efficacious in failed back surgery syndrome (FBSS) and complex regional pain syndrome (CRPS) type I (level B recommendation). High-frequency transcutaneous electrical nerve stimulation (TENS) may be better than placebo (level C) although worse than electro-acupuncture (level B). One kind of repetitive transcranial magnetic stimulation (rTMS) has transient efficacy in central and peripheral neuropathic pains (level B). Motor cortex stimulation (MCS) is efficacious in central post-stroke and facial pain (level C). Deep brain stimulation (DBS) should only be performed in experienced centres. Evidence for implanted peripheral stimulations is inadequate. TENS and r-TMS are non-invasive and suitable as preliminary or add-on therapies. Further controlled trials are warranted for SCS in conditions other than failed back surgery syndrome and CRPS and for MCS and DBS in general. These chronically implanted techniques provide satisfactory pain relief in many patients, including those resistant to medication or other means. [source] Neuropathic pain is enhanced in ,-opioid receptor knockout miceEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 3 2006Xavier Nadal Abstract We have evaluated the possible involvement of ,-opioid receptor (DOR) in the development and expression of neuropathic pain. For this purpose, partial ligation of the sciatic nerve was performed in DOR knockout mice and wild-type littermates. The development of mechanical and thermal allodynia, as well as thermal hyperalgesia was evaluated by using the von Frey filament model, the cold-plate test and the plantar test, respectively. In wild-type and DOR knockout mice, sciatic nerve injury led to a neuropathic pain syndrome revealed in these nociceptive behavioural tests. However, the development of mechanical and thermal allodynia, and thermal hyperalgesia was significantly enhanced in DOR knockout mice. These results reveal the involvement of DOR in the control of neuropathic pain and suggest a new potential therapeutic use of DOR agonists. [source] Vulvar Pain: A Phenomenological Study of Couples in Search of Effective Diagnosis and TreatmentFAMILY PROCESS, Issue 2 2008JENNIFER J. CONNOR PH.D. Vulvar vestibulitis syndrome (VVS), a vulvar pain disorder, continues to puzzle medical and mental health professionals due to its unknown etiology and lack of effective treatment. This study used transcendental phenomenology methodology to explore the experiences of couples in which the woman has a diagnosis of VVS. Sixteen in-depth semi-structured interviews were conducted with 13 heterosexual couples and 3 women. Four essences emerged: (1) In search of, the medical journey required extensive searching for knowledgeable and respectful practitioners to provide treatment. (2) The process of developing a personal understanding of this disorder led many couples to question their role in causing and maintaining VVS. (3) Developing strategies for coping with painful intercourse led to three strategies: becoming non-sexual, using alternatives to vaginal sex, and altering or enduring painful intercourse. (4) Feelings of isolation were experienced as adapting to this chronic pain syndrome was often a lonely process. Clinical suggestions included: treating the couple, not just the woman with VVS; encouraging couples to broaden definitions about the importance and primacy of vaginal intercourse and suggest alternative sexual activities less likely to cause vulvar pain; developing shared meaning as a couple, and assisting couples in locating physicians and resources. Suggestions are relevant for couples with VVS and those with chronic health problems affecting sexual relationships. RESUMEN Dolor vulvar: estudio fenomenológico de parejas que buscan un diagnóstico y tratamiento efectivos El síndrome de vestibulitis vulvar (svv), un trastono de dolor vulvar, continúa dejando perplejos a los profesionales de la salud física y mental debido a su etiología desconocida y a la inexistencia de un tratamiento efectivo. Este estudio utilizó metodología fenomenológica experimental para explorar las experiencias de parejas en que a la mujer se le ha diagnosticado el svv. Se llevaron a cabo dieciséis entrevistas (en profundidad y semiestructuradas) con 13 parejas heterosexuales y 3 mujeres, de las que se obtuvieron cuatro conclusiones esenciales: (1) En busca de , la investigación médica requería una búsqueda más exhaustiva de médicos eruditos y respetuosos que aportasen un tratamiento. (2) El proceso de desarrollar una comprensión personal del trastorno condujo a varias parejas a plantearse su papel en la causa y la prolongación del svv. (3) Desarrollar estrategias para afrontar un coito doloroso condujo a tres estrategias: prescindir del sexo, optar por alternativas al sexo vaginal y modificar o soportar el coito doloroso. (4) Se experimentaron sensaciones de aislamiento, pues el proceso de adaptación a este síndrome de dolor crónico resultó, a menudo, un proceso solitario. Entre los consejos clínicos se incluyen tratar a la pareja, y no sólo a la mujer con svv; animar a las parejas a ampliar las definiciones de la importancia y preferencia por el coito vaginal, así como sugerir actividades sexuales con menor riesgo de causar dolor vulvar; desarrollar un significado común como pareja; y ayudar a las parejas a encontrar médicos y recursos. Palabras clave: síndrome de vestibulitis vulvar; dolor vulvar; terapia de pareja. [source] Osteopathy for treatment of chronic abacterial prostatitis and chronic pelvic pain syndromeFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 2 2010Article first published online: 14 JUN 2010 [source] The health status burden of people with fibromyalgia: a review of studies that assessed health status with the SF-36 or the SF-12INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 1 2008D. L. Hoffman Summary Objective:, The current review describes how the health status profile of people with fibromyalgia (FM) compares to that of people in the general population and patients with other health conditions. Methods:, A review of 37 studies of FM that measured health status with the 36-item Medical Outcomes Study Short-Form Health Survey (SF-36) or the 12-item Short-Form Health Survey (SF-12). Results:, Studies performed worldwide showed that FM groups were significantly more impaired than people in the general population on all eight health status domains assessed. These domains include physical functioning, role functioning difficulties caused by physical problems, bodily pain, general health, vitality (energy vs. fatigue), social functioning, role functioning difficulties caused by emotional problems and mental health. FM groups had mental health summary scores that fell 1 standard deviation (SD) below the general population mean, and physical health summary scores that fell 2 SD below the general population mean. FM groups also had a poorer overall health status compared to those with other specific pain conditions. FM groups had similar or significantly lower (poorer) physical and mental health status scores compared to those with rheumatoid arthritis, osteoarthritis, osteoporosis, systemic lupus erythematosus, myofacial pain syndrome, primary Sjögren's syndrome and others. FM groups scored significantly lower than the pain condition groups mentioned above on domains of bodily pain and vitality. Health status impairments in pain and vitality are consistent with core features of FM. Conclusions:, People with FM had an overall health status burden that was greater in magnitude compared to people with other specific pain conditions that are widely accepted as impairing. [source] Diagnostic criteria in patients with complex regional pain syndrome assessed in an out-patient clinicACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2010E. A. M. VAN BODEGRAVEN HOF Background: Specific criteria have been described and accepted worldwide for diagnosing patients with complex regional pain syndrome (CRPS). Nevertheless, a clear-cut diagnosis cannot be confirmed in a number of cases. Aim: The objective of this study was to investigate the effectiveness of the described diagnostic criteria used by several clinical disciplines. Methods: We included 195 patients who were referred to our pain clinic within a period of 1 year. Data were collected on patient characteristics, signs, symptoms, disease-related medication, and the background of the referring clinicians. Results: The Harden and Bruehl criteria were confirmed in 95 patients (49%). These patients used a higher than average number of analgesics, opiates, and anti-oxidants, and frequently received prescriptions for benzodiazepines instead of anti-depressants. The mean disease duration was 29 ± 4.6 months and the mean visual analogue score for pain was 8.1 ± 0.19. A subgroup of patients had a colder temperature in the affected extremity compared with the unaffected extremity. This subgroup showed a longer disease duration and higher visual analogue scale pain. Conclusion: The diagnostic criteria used to determine CRPS should be further improved. A large number of referred patients experienced substantial pain, without receiving adequate medication. Disease-related medication is unrelated to CRPS-specific disease activity. Knowledge of underlying mechanisms is warranted before an adequate pharmaceutical intervention can be considered. [source] Chronic Pain: Nursing Diagnosis or Syndrome?INTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 4 2001Diná Almeida Lopes Monteiro Cruz PhD PROBLEM. To explore the existence of a pattern of nursing diagnoses that represents a chronic pain syndrome. METHODS. The nursing diagnoses of 68 oncologic and 46 nononcologic patients with chronic pain were submitted to univariate and multivariate analyses. Diagnoses ranked above the 75th percentile, without association with pain etiology, and presenting a pattern in cluster analyses and multidimensional scaling was accepted as possible components of chronic pain syndrome. FINDINGS. The possible components of chronic pain syndrome were disturbed sleep pattern,a constipation or risk for constipation, deficient knowledge,a impaired physical mobility, and anxiety/fear. CONCLUSIONS. Although a pattern of diagnoses has been proposed, confirmation will require further studies and the exploration of the clinical usefulness of the concept of chronic pain as a syndrome. PRACTICE IMPLICATIONS. Increased skill in the assessment and understanding of chronic pain can result in improved relief strategies. Douleur chronique: Diagnostic infirmier ou syndrome? PROBLÈME. Explorer l'existence d'un regroupement de diagnostics infirmiers représentant le syndrome de douleur chronique (SDC). MÉTHODES. Les diagnostics infirmiers présents chez 68 patients cancéreux et 46 patients non-cancéreux, souffrant de douleur chronique furent soumis à des analyses unidimensionnelles et multidimensionnelles. Les diagnostics qui furent retenus comme composantes possibles du SDC se situaient au dessus du 75e percentile, n'étaient pas associés à l'étiologie et représentaient un ensemble dans les analyses de regroupement et l'échelle multidimensionnelle. RÉSULTATS. Les composantes possibles du SDC furent perturbation des habitudes de sommeil, constipation ou risque de constipation, manque de connaissances, altération de la mobilité et anxiété/peur. CONCLUSIONS. Même si un schéma de diagnostics infirmiers a été proposé, il faudrait encore entreprendre plusieurs recherches et explorer l'utilité clinique du concept syndrome de douleur chronique, avant de confirmer la pertinence de ce syndrome. IMPLICATIONS PRATIQUES. L'amélioration de l'évaluation et de la compréhension de la douleur chronique peut conduire à de meilleures stratégies pour soulager la douleur. PROBLEMA. Explorar a existência de um padrão de diagnósticos de enfermagem que represente uma síndrome de dor crônica. MÉTODOS. Diagnóstics de enfermagem de 68 pacientes com dor crônica oncológica e 46 pacientes com dor crônica não oncológica foram submetidos a análises univariadas e multivariadas. Os diagnóstics posicionados acima do Percentil 75, sem associação com a etiologia da dor e que apresentaram um padrão na Análise de Cluster e no Escalonamento Multidimensional foram aceitos como possíveis componentes da síndrome de dor crónica. RESULTADOS. Os possíveis componentes da síndrome de dor crônica foram: distúrbio do padrão de sono, cnstipação ou risco para constipação, déficit de conhecimento, mobilidade física prejudicada e ansiedade/medo. CONCLUSÕES. Apesar de um padrão de diagnósticos ter sido proposto, a sua confirmação requer outros estudos e a exploração da utilidade clínica de se conceituar a dor crônica como uma síndrome. IMPLIAÇÕES PRÁTICAS. Melhorar a compreensão e as habilidades na avaliação da dor crônica pode resultar em melhores estratégias de alívio. Dolor crónico: Diagnóstico enfermero o síndrome? PROBLEMA. Explorar la existencia de un patrón diagnóstico de enfermería que represente el síndrome de dolor crónico (SDC). MÉTODOS. Los diagnósticos enfermeros de 68 pacientes oncológicos y 46 no-oncológicos con dolor crónico, se sometieron a análisis variable y multivariable. Se aceptaron como posibles componentes del SDC, los diagnósticos que estaban sobre el percentil 75, sin asociación con etiología de dolor y que presentaban un patrón agrupado al hacer el análisis y en la escala multidimensional. RESULTADOS. Los posibles componentes de SDC fueron alteración del patrón del sueño, estreñimiento o riesgo de estreñimiento, déficit de conocimientos, trastorno de la movilidad física y ansiedad/temor. CONCLUSIONES. Aunque un patrón de diagnósticos ha sido propuesto, la confirmación requerirá que se llevan más allá los estudios y la exploración de la utilidad clínica del concepto del dolor crónico, como un síndrome. IMPLICACIONES PARA LA PRÁCTICA. Mejorar la habilidad en la valoración y comprensión del dolor crónico pueden producir mejoras en las estrategias de alivio. [source] Interstitial cystitis, gynecologic pelvic pain, prostatitis, and their epidemiologyINTERNATIONAL JOURNAL OF UROLOGY, Issue 2003ANANIAS C. DIOKNO Abstract Aim: To determine a uniform definition of interstitial cystitis (IC) and to develop a strategy on how to study its epidemiology. Methods: Initially, the committee reviewed the literature regarding the definition of IC currently being used and information regarding its epidemiology. The committee held three 1-hour hearings and discussions on the opinions of invited IC specialists. The issues were presented and discussed. Consensus was sought when possible. The committee members met and summarized the gist of the three sessions. Results: A consensus emerged as to what constitutes IC. Interstitial cystitis must have the elements of chronic pelvic pain and urinary frequency and/or urgency. It was also the recommendation that the term IC be retained followed by chronic pelvic pain syndrome represented by the acronym IC/CPPS. A strategy on the epidemiologic study of IC/CPPS was also recommended. Conclusions: A consensus from this workshop has emerged in terms of defining the component of IC, the preferred terminology, and the strategy to study its epidemiology. [source] Referral and treatment patterns for complex regional pain syndrome in the NetherlandsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2009M. DE MOS Background: Patients with complex regional pain syndrome (CRPS) are seen and treated by a variety of physicians. The present study aims to describe referral and treatment patterns for CRPS patients in the Netherlands. Methods: Patients, who were selected (1996,2005) from an electronic general practice (GP) database (Integrated Primary Care Information Project), were invited for study participation, involving diagnosis verification (International Association for the Study of Pain criteria) and assessment of referrals and treatment through information retrieved from GP journals, patients' questionnaires, pharmacy dispensing lists and specialist letters if available. Results: One hundred and two patients were included. Sixty-one percent had presented first at the GP, while 80% subsequently consulted one or more medical specialists, most frequently an anesthetist (55% of the cases) or a specialist in rehabilitation medicine (41%). Over 90% of the patients received oral or topical pharmacotherapy, 45% received intravenous therapy, 89% received non-invasive therapy (i.e. physiotherapy) and 18% received nerve blocks. Analgesics and free radical scavengers were administered early during CRPS, while vasodilating drugs and drugs against neuropathic pain (antidepressants and anti-epileptics) were administered later on. Pharmacotherapy was usually initiated by a medical specialist. Conclusion: The Dutch treatment guidelines, issued in 2006, recommend free radical scavenger prescription (plus physiotherapy) as the initial treatment step for CRPS. Until 2005 only half of the patients received a scavenger within 3 months after disease onset, and the majority presents first at the GP, in particular GPs may be encouraged to initiate treatment with scavengers, while waiting for the results of further specialist consultation. [source] Psychiatric disorders and family functioning in children and adolescents with functional abdominal pain syndromeJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 7pt1 2008Ahmad Ghanizadeh Abstract Background and Aim:, Functional abdominal pain syndrome (FAPS) is a functional gastrointestinal disorder. There is a heightened risk when conducting potentially dangerous and unnecessary medical investigations and procedures in children with FAPS. The aim of this study was to survey the rate of the psychiatric disorders and family functioning in children and adolescents with FAPS. Methods:, The subjects were a consecutive new sample of 45 children and adolescents with FAPS, 45 with an organic abdominal pain, and 45 pain-free comparison subjects aged 5,18 years that were interviewed using the Farsi version of K-SADS. Family functioning and the severity of pain were also studied. Results:, About 51.1% of patients with FAPS suffered from at least one psychiatric disorder. Psychiatric disorders in the FAPS patients studied included general anxiety disorder (8.9%), obsessive-compulsive disorder (11.1%), attention deficit hyperactivity disorder (15.6%), separation anxiety disorder (24.4%), and major depressive disorder (15.6%). Except for generalized anxiety disorder and tic disorder, the other disorders were significantly more common in the FAPS group than in the two other control groups. Family functioning scores were not significantly different between groups. Discussion:, There is a high rate of psychiatric disorders in children and adolescents with FAPS in Iran, but our study found fewer incidences of disorders than previous reports have indicated. Family dysfunction difficulties in FAPS children are not more common than those in the control groups. [source] Simultaneous feedforward recruitment of the vasti in untrained postural tasks can be restored by physical therapyJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 3 2003Sallie M. Cowan Abstract Background and purpose: Physical therapy rehabilitation strategies are commonly directed at the alteration of muscle recruitment in functional movements. The aim of this study was to investigate whether feedforward strategies of the vasti in people with patellofemoral pain syndrome can be changed by a physical therapy treatment program in a randomised, double blind, placebo controlled trial. Subjects: Forty (25 female, 15 male) subjects aged 40 yrs or less (27.2 ± 7.8 yrs). Methods: Subjects were allocated to either a placebo treatment or a physical therapy intervention program. The postural challenge used as the outcome measure was not included in the training program. Electromyography (EMG) onsets of vastus medialis obliquus (VMO), vastus lateralis (VL), tibialis anterior and soleus were assessed before and after the six week standardised treatment programs. Results: At baseline the EMG onset of VL occurred prior to that of VMO in both subject groups. Following physical therapy intervention there was a significant change in the time of onset of EMG of VMO compared to VL with the onsets occurring simultaneously. This change was associated with a reduction in symptoms. In contrast, following placebo intervention the EMG onset of VL still occurred prior to that of VMO. Conclusion and discussion: The results indicate that the feedforward strategy used by the central nervous system to control the patella can be restored. Importantly, the data suggest that this intervention produced a change that was transferred to a task that was not specifically included in the training program. Furthermore, the change in motor control was associated with clinical improvement in symptoms. © 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved. [source] | |||||||||||||||||||||||||||||||||||||